Allogeneic Stem Cell Transplant
February 15th, 2021
Overview
An allogeneic stem cell transplant involves depleting a patient's bone marrow using chemotherapy, and then transfusing another (matched) patient's stem cells. This serves purposes of both replacing their haematopoietic cells with normal cells, and providing some degree of graft-vs-disease effect.
Allogeneic stem cell transplants are associated with a high risk of complications and mortality, and require long-term immunosuppression.
Ask About
- Peritransplant history - when the transplant was done, indication, type of transplant, conditioning
- Complications
- Post-transplant management
Peritransplant History
Ask About
- When
- Indication for allogeneic stem cell transplant
- Type of transplant - syngeneic, matched sibling, MUD, haploidentical, cord blood
- Donor - HLA match, CMV status
- Recipient - CMV status
- Conditioning - myeloablative or reduced intensity (RIC)
Indications for Allogeneic Stem Cell Transplant
- Acute myeloblastic leukaemia
- Acute lymphoblastic leukaemia
- Aplastic anaemia
- Relapsed refractory lymphoma
Types of Allogeneic Stem Cell Transplant
- Syngeneic allograft - identical twin donor with the same major and minor HLA antigens
- Matched sibling allograft - all major HLA antigens matched; minor antigens more likely to match
- Matched unrelated donor (MUD) allograft - major HLA antigens matched; minor antigens partially matched
- Mismatched unrelated donor allograft- some major and minor HLA antigens matched
- Haploidentical allograft (unmatched sibling, parent, child or other family member) - half of major HLA antigens matched
- Cord blood allograft
Complications
Complications of Allogeneic Stem Cell Transplant
Infectious
- Fungal infections - candida, aspergillus, cryptococcus
- Viral infections - herpes simplex, varicella, CMV, EBV, influenza, BK virus, JC virus
- Bacterial infections - mycobacterial, pneumococcal
- Protozoal infections - pneumocystis, toxoplasmosis
Non-Infectious
- Mucositis
- Bone marrow suppression
- Graft vs host disease (GVHD) - acute / chronic
- Post-transplant lymphoproliferative disorder
- Sinusoidal obstructive syndrome (jaundice, hepatomegaly, fluid retention)
- Rejection
- Disease relapse
Post-Transplant Management
Management Strategy
- Transfusion support
- GVHD prophylaxis - cyclosporine, methotrexate
- Infective prophylaxis - e.g. bactrim, posaconazole, ganciclovir / valganciclovir
- Vaccinations
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